Congenital Rubella Syndrome Alert

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Congenital Rubella Syndrome Alert Powered By Docstoc
					January 18, 1999                                                                      Vol. 59, No. 2

Congenital Rubella Syndrome Alert
On January 6, the Texas Department of Health alerted medical and hospital personnel of the possibil-
ity of babies being born with congenital rubella syndrome (CRS) in their facilities. As of that date,
CRS had been confirmed in 2 babies in Texas--one born December 1 in Dallas County and the other
in El Paso County on December 7.




I
    n 1998 Texas experienced an outbreak of         Infected infants may shed virus to all contacts
        rubella, a vaccine-preventable disease.     for up to one year. Therefore, it is important
        Congential rubella syndrome (CRS),          that babies suspected at birth of having CRS
by far the most important consequence of            be placed in isolation immediately. It is also
rubella, impacts up to 85% of infants born          important that all hospital and medical per-
to mothers infected with rubella in their first     sonnel be immune to rubella to avoid further
trimester of pregnancy.                             transmission of the disease to susceptible
                                                    pregnant women.
A clinical case of CRS is an illness of new-
borns resulting from rubella infection in utero.    Health care workers with documented
The most commonly described anomalies               evidence of at least one dose of a rubella-
                                                    containing vaccine or serologic evidence of
associated with CRS are as follows:
                                                    immunity to rubella are considered protected
• Ophthalmologic: cataracts and pigmentary          against the disease. Although many persons
  retinopathy                                       born before 1957 may have had rubella dis-
• Cardiac: patent ductus arteriosus, pulmo-         ease, there is no guarantee that older health
  nary artery stenosis                              care workers are already immune. Any
• Auditory: sensorineural deafness                  health care workers who may put themselves
• Neurologic: behavioral disorders, meningo-        or others at risk should have their immune
  encephalitis, mental retardation                  status tested and be vaccinated if necessary.

In addition, infants with CRS may have              Eighty-nine (89) cases of rubella were con-
interuterine growth retardation, thrombocy-         firmed in Texas in 1998 - more than seven
topenia, hepatosplenomegaly, radiolucent            times the number of cases reported through-
bone disease, and purple skin lesions ("blue-       out the entire year of 1997 (Figure 1). The
berry muffin" appearance).                          most recent confirmed case was in mid-
                                                    October 1998. Because rubella peaked in Texas
Some infants with intrauterine infection have       during March and April 1998, women in-
few or no symptoms at birth but develop             fected early in their pregnancies during this
severe multisystem disease after a latent period    period would be expected to deliver anytime
of several months. Notable manifestations of        now through the early part of 1999 (Figure 2).
late-onset CRS are a generalized interstitial
pneumonitis associated with cough, tachyp-          An outbreak of rubella continues in Mexico
nea, and cyanosis; chronic rubelliform rash;        with over 41,000 cases reported during 1998.
chronic diarrhea; recurrent infections due          Because of Texas’ proximity to Mexico, health
to immune system defects; and progressive           care providers are urged to increase the
neurological deterioration. Endocrine ab-                                              Continued F
normalities associated with an increase in
autoantibodies may be observed. Insulin-
dependent diabetes mellitis, hypothyroidism,        Also in this issue:
and throtoxicosis manifest at several years of          Bimonthly Statistical Summary
age in children with CRS.                               Vaccine Preventable Disease Update
                                                        Calling All Reports
     Page 2                                     January 18, 1999                                                DPN
Figure 1. Reported Cases of Rubella and CRS in Texas by County, 1998
County             Rubella                  CRS              County                Rubella                  CRS
Bell                        1                   0
                                                             Jefferson                      1                   0
Cameron                    24                   0
                                                             Montgomery                     1                   0
Dallas                      1                   1
                                                             Nueces                         3                   0
Denton                      6                   0
                                                             Rockwall                       1                   0
El Paso                     8                   1
                                                             Tarrant                        1                   0
Galveston                   1                   0
                                                             Travis                         8                   0
Harris                     22                   0
                                                             Willacy                        1                   0
Hidalgo                    10                   0
                                                             TOTALS                     89                      2


sensitivity of their rubella surveillance.                   Rubella is usually a very mild illness, and
Persons presenting with a low-grade                          only 50% of infected persons have
fever or rash - particularly if they have                    symptoms. It is very likely, therefore,
recently traveled in Mexico or grew up                       that persons infected with rubella may
in a foreign country - should be suspect-                    unknowingly spread the disease to oth-
ed of having rubella, and appropriate                        ers.
diagnostic clinical specimens should be
obtained.

     A clinical case of rubella is an illness with the following characteristics:
     • acute onset of a fine pink or red rash
     •temperature greater than 99oF (37.2oC) and
     • joint pain or
     • swelling and tenderness of the lymph glands (particularly behind the ears) or
     • conjunctivitis (red, watery eyes)

Figure 2. Rubella in Texas by Month of Onset, 1997 and 1998
No.
30

25

20

15

10

 5

 0
       J   F   M   A   M   J    J   A   S   O    N   D   J    F   M    A   M   J    J   A       S   O   N   D
                                                 Month of Onset



                                                                      Prepared by the Texas Department
                                                                      of Health Immunization Division.
                                                                                           Bim onthly Statistical Sum m ary of Selected Reportable Diseases
         Nov/Dec 1998
                                                                                       HHSC Region                                                                             Selected Texas Counties                                        This Period          Cum ulative[1]

Selected Diseases/Conditions                     1        2          3        4        5        6        7        8        9        10        11       Bexar       Dal l as   E l P as o   Harri s   Hi dal go   Nueces Tarrant   T r avi s   1997       1998      1997       1998

Sexually Transm itted Diseases[2]

      Syphilis, primary and secondary                *0       *1     *26          *1       *7   *12          *4       *5       *0        *1    *0         *5          *22             *1      *10          *0        *0      *4         *0         *78     *57         *676     *411
      Congenit al Syphilis                           *0       *0         *1       *0       *0       *6       *0       *0       *0    *0        *0         *0            *1           *0        *6          *0        *0      *0         *0         *24        *7       *164      *85
      Resist ant Neisseria gonorrhoeae               *0       *0         *0       *0       *0       *0       *0       *0       *0    *0        *0         *0            *0           *0         *0         *0        *0      *0         *0          *1        *0        *10          *8

Enteric Diseases

      Salmonellosis                                  31       11      36          9        6    68       45        26          5         8     19          5            11            8        63            8        3       7        20         678     264          2361     3064
      Shigellosis                                120      19          47          7    16       72       52           41       4         8     36         14           19             8        57            5        0      11        28         806     422          2631     3388
      Hepat it is A                               25      33          33          2    14           3    27           31       7         2     44         28             4            2          3         12         2       6        19         784      221      3882        3282
      Campylobact eriosis                         14           1         7        4         1       4    15        16           1        1         8      10              1            1         2           0        4       2        10         125         72       845       729

Bacterial Infections

      H. influenzae t ype b, inv asiv e              0        0          0        0        0        0        0         0       0         0         0       0             0            0          0           0        0       0           0         0         0           5          3
      Meningococcal, inv asiv e                      0        0          3        0         1       0        0         0       0         0         0       0             0            0          0           0        0       0           0        22         0         161      163
      Lyme disease                                   0        0          0         1       0        0        0         0       0         0         0       0             0            0          0           0        0       0           0         11        0         56           23
      Vibrio species                                 0        0          0        0        0        0        0         0       0         0         0       0             0            0          0           0        0       0           0        10         0         36           14

Other Conditions

      A I DS[4]                                   16          4      127      10           0    223      36        37          2     13        19         31           78            13      204             7        4     24         15         843     489       4685        4039
      Hepat it is B                                   1       0          3        0        0        0        2         0       0         1         0       0             0             1         0           0        0       0           0         0         7           0      944
      A dult elev at ed blood lead lev els           0        0      127          2        0    19            1        4       2         0         0       0           17             0          0           0        0       2           0       215     155       1617        1295
      A nimal rabies - t ot al                       0        9          2        2        0        0        4         4       5         1         0           1         0            0          0           0        0       0           0        26         27       266       410
      A nimal rabies - dogs and cat s                0        3           1       0        0        0        0         0       0         1         0       0             0            0          0           0        0       0           0         2         5         13           21

Tuberculosis Disease[2]

      Children ( 0-14 years)                         *1       *0         *0       *0       *0       *4       *1       *0       *1    *0        *3         *0            *0           *0        *4           *1       *0      *0          *1        *11     *10         *131     *129
      A dult s ( >14 years)                          *5       *4     *46          *7       *3   *83      *23      *22          *5   *14       *22        *14           *31         *14        *56          *5        *3     *12         *9        *297    *234     *1781       *1546

Injuries[2]

      Spinal Cord I njuries ( 5)                     0         1         6        0        0        6        0         0       0         0         0       0              1           0          3           0        0       2           0        17         13         91          79


       1. Cumulat iv e t o t his mont h. 2. Dat a for t he ST D's, T uberculosis, and spinal cord injuries are prov ided by dat e of report , rat her t han dat e of onset . 3. Volunt ary report ing. 4. A I DS t ot als
      include report ed cases from T exas Depart ment of Correct ions, which are not included in t he regional and count y t ot als. 5. 6 report s were missing PHR ident ificat ion *Dat a incomplet e.

                                                          Call 1-800-705-8868 to report
                                                                                                                                                                                                                                              1
                                                                     1997 POPULATION ESTIMATES

                                 1997 HHSC REGIONS                                                                              SELECTED COUNTIES                                                                                                    2        3     4
  1        764,497        4       957,383    7    1,931,454              10       743,763                     Bexar        1,324,190                    Hidalgo                   492,619                                                     9               7         5
  2        533,392       5        687,951    8    2,017,179               11 1,607,762                        Dallas       2,099,876                    Nueces                    311,154
                                                                                                                                                                                                                                  10                               6
                                                                                                                                                                                                                                                     8
  3      5,104,222        6      4,404,421   9        555,363                                                 El Paso          715,807                  Tarrant                1,427,664
                                                                                                                                                                                                                   HHSC                                  11
                  STATEWIDE TOTAL                                  19,307,387                                 Harris       3,163,342                    Travis                    632,922
                              Disease Prevention News (DPN)
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Walter D. Wilkerson, Jr., MD, Chair
Texas Board of Health
William R. Archer III, MD, Commissioner of Health

Debra Stabeno, Deputy Commissioner for Public
Health Sciences and Quality

Diane Simpson, PhD, MD, State Epidemiologist,
Associate Commissioner for Disease Control and
Prevention
Kate Hendricks, MD, MPH&TM, Medical Editor
Mark Gregg, MA, Director,
Public Health Professional Education
Susan Hammack, MEd, Managing Editor
Linda Darlington, Production Assistant




                                              Vaccine-Preventable Disease Update
                                       Reported Cases with Onset From 11/01/98-12/31/98

                                                                          Number       Date

                                                Condition    County       of Cases    of Onset
                                                Mumps        Deaf Smith      1         11/24
                                                Pertussis    Bexar           1         12/07
                                                             Colorado        1         11/15
                                                             Guadalupe       1         11/04
                                                             Matagorda       1         11/21
                                                Rubella      Dallas          1         12/01
                                                             El Paso         1         12/07
                                                YTD          Mumps        Pertussis    Rubella
                                                               1             4           2




           Calling All Reports:
           The Infectious Disease Epidemiology & Surveillance Division is currently processing 1998 disease
           data for our year-end transmission to CDC. To help us meet our deadlines, if you are a health pro-
           fessional or work for an organization required to report, please submit all 1998 infectious disease
           reports no later than March 30, 1998. We will not be able to send CDC any 1998 reports received
           after March 30, 1999; thus, late reports will not be counted in the 1998 morbidity data for Texas. If
           you have any questions, please contact Julie Rawlings at (512) 458-7228.

				
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